by LaGreca, Gen
The technician played a sonatina on the keyboard. The machine hummed. A new image appeared. The two surgeons leaned over the screen, gray hair next to black. While Nicole lay unconscious, the doctors scrutinized an overhead view of her brain sliced horizontally at the floor of the skull. Nicole’s eyes were prominent white orbs. The trail of the optic nerves extended from each eye, tracing the familiar wide X across the brain. The fragile sinus bones that formed the cranial floor under the nerves were a contrasting hue. But the pattern of the bones and nerves was not a smooth one. An abnormality appeared just before the intersection of the nerves.
“Look, there’s a disruption of the nerves in the optic canal,” said the ophthalmologist.
“Magnify that,” David murmured almost inaudibly, too absorbed in thought to raise his voice.
While the technician played the keyboard, David wondered what mystery the next frame would reveal. What was the cause of the disruption they were seeing? Would there be a hemorrhage in the optic nerves from blood vessels ruptured in the fall? He could stop the bleeding and restore vision. Would hematomas—blood clots—be pressing on the optic nerves, blocking their function? He could remove the clots and restore vision. Would he find that edema—swelling—of the nerves was impeding their work? He could reduce the swelling and restore vision. Would the fracture on the floor of the skull have caused bone to press against the taut nerves in the optic canal? He could decompress the fragile nerves and thereby restore vision. He could and he would because he most desperately had to restore vision.
He leaned closer to the monitor. The technician pressed buttons. The machine hummed and vibrated. The next picture flashing on the screen cast a dark shadow across David’s face. He gasped.
“Oh, no!” the ophthalmologist cried.
David’s body stiffened behind the two men. He stared through the window at Nicole suspended in space. He knew the diagnosis. The image on the screen told him everything that the ophthalmologist would now say. The older doctor remained deeply engrossed in the brain scan, unaware that David’s hands had left the table, just as his eyes had left the screen and his thoughts had left the room.
“Oh, the poor thing! What a pity!” exclaimed the eye surgeon.
David did not see an object of pity. Under the folds of the thin sheet, he saw the exciting vitality of Nicole’s body, the striking pattern of taut lines and graceful curves, the flesh that was firm and supple. He saw a figure carved by a loving sculptor who masterfully mixed strength with softness to create beauty.
He thought of an ancient statue that he had seen of a goddess with wings, a statue that had stood on the prow of a ship as a symbol of victory. The sculptor had captured the deity descending onto the ship, with one foot touching the prow, the other still in flight. The eight-foot-high marble lady moved against a gusting head wind palpable in the fullness of her wings, the zesty swing of her robe behind her, the thrust of her body forward. The flowing drapery of her robe revealed the vibrant sensuality of a woman’s body. Sea-soaked and windswept, the voluminous garment clung to the front of her body like a transparent film, encircling her breasts, stretching against her taut stomach, highlighting the long lines of her legs. The statue’s pose revealed her spirit. Her arrogant thrust forward and visible delight at the touch of the sea and wind was more than a call to victory—it was an exaltation of victory, a triumph not merely over an enemy at sea but the triumph of the human spirit celebrated in the soaring body of a goddess with wings. The graceful movement of the stone lady had reminded David of a dancer. The statue had no head; it had been lost in the rubble of centuries. At that moment in the imaging room, David envisioned the winged goddess with Nicole’s radiant face.
The ophthalmologist continued to study the scan. “The fracture of the sphenoid bone did the damage. It must have hit with some force, because it cut right through the dura.”
The dura mater, Latin for “hard mother,” is the outer membrane covering the spinal cord and brain. The dura forms sheaths around the optic nerves.
“With the dura cut,” the ophthalmologist continued, “you can see the injury to the nerves. What a tragedy!”
The eye surgeon’s final word was like a heavy weight on the goddess’s ship. David knew that such ballast would not sink the marble lady. One sweep of her giant wings would cast the unwanted load out to sea. Was tragedy to be Nicole’s fate, he wondered—and his own? Could he abandon her to defeat, pain, and misery? Or could he change her destiny to that of the stone goddess—to triumph?
The ophthalmologist rose from his chair and turned to face his younger colleague, pulling David’s thoughts back into the room.
“There’s nothing you can do, David. A fragment dislodged from the fractured bone on the cranial floor and transected the optic nerves. They’re both completely severed. The situation is hopeless. She’ll never see again.”
David did not reply.
“You know as well as I do, David, that the optic nerve is identical to the white matter of the brain; therefore, it’s incapable of regeneration.”
“Do I?”
* * * * *
The floor, the walls, and the fluorescent-lighted ceiling of Nicole’s hospital room were devoid of color. Outside the window, David observed a lively blue jay fluttering in a willow-green tree, performing its early evening grooming. The little bird’s world was bright, but Nicole’s was dark, he thought absently, sitting on the bed, watching her. She was still unconscious but was stirring and about to awaken. He found it ironic to be bringing her news that her sight had vanished, when she had sparked his own existence with such a vibrant light. Although he sat right next to her, his still pose, his furrowed brow, and his pensive gaze distanced him, as if he were pulled away by an inner conflict.
She stretched her arms, tossed her head, and opened her eyes. She blinked, at first dazed, then with a growing sense of her new condition. The sublime tranquility of sleep vanished, and a cry of horror formed on her lips. She reached up to touch her eyes.
He gently pulled her hands down to her waist and held them in his own. He watched her sympathetically, his focus seeming to return to the room, as if he had resolved the matter tugging at him.
“Don’t rub your eyes, Nicole. I’m afraid it won’t help.”
“I . . . I can’t see! I can’t see!”
“I know.” He squeezed her hands. “You’re in a hospital. There was an explosion. Do you remember falling?”
“Yes, yes, I fell!”
She was trembling. She tossed restlessly, fighting off the grogginess, struggling to regain full awareness. She tried to sit up, but he gently pushed her shoulders back against the bed.
“Not so fast—you’ve had quite a fall.”
The muscles that moved her eyes were unaffected by the injury, so they continued to focus with an eerie vitality.
“I’m a neurosurgeon—David Lang.”
“What’s wrong with my eyes?”
“You’ve had an injury.”
“Why can’t I see, Doctor?” The voice—and the fear in it—were growing stronger.
He hesitated.
For the first time, David had to be coaxed by a patient. “If you want to be kind, you’ll just tell me straight.”
“You fell on your face and broke your nose. A bone fragment got loose and . . . pierced the optic nerves. I’m afraid they’re . . . severed, Nicole. That’s why you can’t see.”
“And . . . what does that mean?”
He felt her hands become wet and icy.
“In the past, that meant that you . . .”—his voice dropped—“would not see . . . again.”
“Oh, no! That can’t be! This is the end of me! I want to die! Help me to die, Doctor! I want to die!”
Her hands broke away from his and pulled at her hair. She cried furiously, convulsively, interminably. Her immense capacity for joy was matched by the violence of her anguish. Each cry was like a knife slashing his skin. He waited, as if caught in a storm that had to run its cours
e. Her tears soaked the lustrous hair around her face until the strands became dark, straight, and coarse. Then she seemed to remember something that stopped her cries abruptly. “What did you mean when you said ‘in the past’?”
“There’s a new procedure that might help you.”
A hint of hope colored her face.
“I hasten to add that it’s experimental. It’s never been tested on a human before and the animal research is incomplete, so I can make no claims about its outcome. But this procedure has been tried on some laboratory animals, and it has regenerated severed tissue like that of your optic nerves and restored lost function.”
Her eyes retained a haunting intelligence.
“It would require two brain surgeries, Nicole, and since it’s unproven in humans, it’s hard to say what the chances are that it will help you. I’d say they’re slim.”
“What are my chances without it?”
His voice softened. “Your brain scans clearly show that the nerves are completely severed. Unfortunately, they just don’t repair themselves.”
“And there is no other treatment?”
“I’m afraid not.”
“Then the procedure you mention is my only chance?”
“Which is why I offered it.”
“Doctor, I would try this new treatment even if my chances of dying from it were ninety-five percent.”
“I wouldn’t. If I thought there was a serious risk to your life, I wouldn’t operate. I have no evidence that the new procedure is any more dangerous than many other brain surgeries. That’s why, while you were unconscious, I thought this thing over and decided to offer the treatment, even though it’s experimental. However, I must stress that there are risks inherent in brain surgery, which I’ll explain and which you should consider seriously.”
Her voice broke as she tried to speak. “The risk to my life is this . . . horrible injury. I feel helpless. I’m scared . . . very scared.”
He thought it useless to try to convince her that she could live with total, permanent blindness. He shared her desperate desire for a cure. Wasn’t that why he had become a doctor—and why he was about to do the unthinkable?
“You see, Doctor, I have something I do—my work—that means . . . so very much to me. I couldn’t do it . . . blind. But it’s more than that. I’ve never been . . . helpless. I’ve always been on my own, able to look after myself. I’d risk everything to save the one thing I . . . I couldn’t live without. Can you understand that, Doctor?”
“Yes.”
The solemnity of his voice encouraged her to say more.
“Life would mean nothing to me if I couldn’t be . . . free. Do you know what I mean?”
“Oh, yes.”
“I’d take a terrible chance, gladly, for the one thing I . . . mustn’t give up. Can you see what I’m up against?”
“Clearly.”
“So you know why I’m most desperately interested in this procedure . . . why I’m . . . most . . . desperate.”
“I do.”
“Who’s the world expert on this treatment? I want only the best person to help me.”
“I am.”
“I believe you.”
Nicole liked confidence. For the first time since her injury, she smiled.
He asked her questions and checked her neurological condition, satisfying himself that she displayed no other impairments. Then he described her injury, indicating the function of the optic nerves and tracing with her fingers on her head their path through the brain. He also explained the risks of brain surgery.
She was alert, listening, asking questions, digesting every word. The knowledge that he gave her was strong medicine for allaying her fears and for restoring a sense of control, even in her desperate situation. This strange new voice with no face, this frame in her mind with no picture, had the power to calm her.
He spoke of the problems of nerve repair and of the treatment that he had devised to overcome them.
“The reason that severed nerves don’t repair themselves,” he explained, “is that they have no capacity to regenerate as broken bones do, coupled with the fact that unwanted scar tissue grows at the sight of the lesion and further impedes the nerves’ function.”
He explained how his procedure stimulated the nerves to grow with his newly discovered embryonic growth protein, and how he could stop the scar interference with another new compound, the scar inhibitor. He told her that the two jobs had to be done in separate surgeries, spaced three months apart, because the two drugs did not work together. She asked questions and he clarified points, until he felt certain that she understood.
“During the time between the surgeries, you should regain some primitive vision, Nicole, but only up to a point. You’ll perceive light, then motion, maybe even color. Because the scar tissue is also growing, it’s unlikely that your vision will advance to the stage of distinguishing objects. Then you’ll reach a point at which the rudimentary vision you’ve regained will begin to diminish, as the growing scar interferes with the growing nerves. I must stress that the timing of the second surgery is critical, Nicole.”
She nodded her head, listening intently.
“We must wait until the nerves regenerate; however, we must not wait until all remnants of your new vision are lost. If that happens, based on my animal experiments, you’ll never regain your sight. So, you’ll need to be available for the second surgery at exactly the right time.”
“Of course, Doctor.”
“And I don’t want to raise false hopes because I can make no promises of success.”
“I understand.”
“If we proceed with the treatment, I don’t want to delay. We have our best chance if I operate immediately; otherwise the nerve ends will start to recede and scar will form quickly, causing complications for me. I don’t even want to wait until tomorrow. But I must be sure I’ve given you enough time to make your decision.”
“I’ve already made it. I want you to go ahead.”
“Don’t you want to discuss the matter with someone?”
“Who?”
“Someone close to you.”
“No one’s close to me,” she said without self-pity.
“Don’t you want to talk to your family?”
“I have no family,” she said simply, as someone else might say, “I have no red dresses.”
“How about the people you love?”
“I don’t love anyone.”
“Don’t you want to consult with someone?”
“Why?”
“To help you in thinking about the matter.”
“Why would I need help?”
“Nicole, I’m trying to assure myself that I have your consent, given to me with full knowledge and careful deliberation.”
“You have.”
Her confident tone convinced him. “All right, but there’s one more thing.”
“Yes?”
“The surgery is illegal.”
“What?”
“It’s illegal. The state prohibits me from doing it and you from having it.”
“How could that be?”
“It is.”
“But then how could you operate?”
“I’m not worried about how I can operate. That’s not why I raised the issue.”
“But won’t you get in trouble?”
“I’m not worried about getting in trouble. That’s not why I raised the issue.”
“Doctor, I’ll sign any papers you wish. I’ll free you from liability. We’ll get witnesses. I’ll swear I begged you to do it—”
“I’m not worried about my liability.”
“I’ll pay you any amount you ask. I’ll pay you triple your fee—”
“I’m not worried about the money. I just want you to know that the government prohibits what I’m about to do in the name of protecting you from me. I mention it in case the state’s edict matters to you.”
“It doesn’t.”
“Then I’ll see you
in surgery.” He squeezed her hands, and then headed toward the door.
“Doctor, wait!”
He walked back to her side.
“I’m . . . afraid.”
“Of what?”
She began to cry.
“What’s the matter, Nicole? Are you having second thoughts?”
“Oh, no! But I’m afraid you will. If the surgery’s against the law, why . . . why should you . . .”
Weak and short of breath, she tried to raise herself. Her arm swept the space around her to find him, to reach out to him. He gently pushed her down.
“You’ll change your mind, Doctor!” she cried, her eyes filled with terror. “You’ll back down!”
He buried two trembling hands in his own larger, steadier ones. “Don’t be afraid, Nicole. I give you my word that I’ll operate. You have my solemn promise.”
He shuddered in the knowledge that this was the second sacred oath he was swearing that day. He reprimanded himself for having made the first one. He detested people who broke their promises. He accused himself of being a liar, but somehow he did not feel ashamed. Lack of remorse is further proof of depravity, he thought, but somehow he did not care. He told himself that he had no right to perform a procedure disapproved of by the governing body of the hospital. Wasn’t he about to violate someone’s property just as surely as hurling a rock through a shopkeeper’s window? But was it the board of directors that was against his procedure? He remembered the tired flesh and weary faces around the conference table that afternoon. He thought of wooden figures pulled by a presence offstage, invisible to the casual viewer. The notion of choice seemed as preposterous to the board as it was to a herd of penned sheep. Was he to sacrifice the irreplaceable treasure that was Nicole’s life and spirit for the sake of honor owed to . . . puppets? Was that integrity? If it was, he would have none of it!
But what of the honor owed to someone else, he wondered, someone whose presence had tormented him from the moment that he diagnosed Nicole’s injury? He shut his eyes painfully against the knowledge that he was about to betray the one man whom he had no capacity to hurt. When he opened his eyes, he saw the one woman whom he had no capacity to refuse.